Provider Demographics
NPI:1972035210
Name:FEGGESTAD, VICTORIA M (RN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:FEGGESTAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:M
Other - Last Name:DREES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:32 E. RACINE STREET
Mailing Address - Street 2:SUITE 150
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545
Mailing Address - Country:US
Mailing Address - Phone:608-754-3722
Mailing Address - Fax:608-754-3132
Practice Address - Street 1:32 E. RACINE STREET
Practice Address - Street 2:SUITE 150
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545
Practice Address - Country:US
Practice Address - Phone:608-754-3722
Practice Address - Fax:608-754-3132
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI123319-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse